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General NPI Number Information
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NPI Number | 1083148449
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Entity Type | Individual
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Provider Name | MASHANDA DESHAZER CNA,CMA,RMA,RP,LVNRN
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Gender | Female
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 10807 MISTY RIVER DR
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City | HOUSTON
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State | TX
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Zip | 77086-1919
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Country | US
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Telephone | 214-277-9439
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Fax |
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Provider Business Mailing Address
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Address Line | 7200 T C JESTER BLVD
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City | HOUSTON
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State | TX
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Zip | 77088-7458
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Country | US
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Telephone | 832-654-0396
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Fax | 832-288-4192
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | NA0010075140
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License Number State | OK
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